Provider Demographics
NPI:1174646707
Name:RUTHERFORD, LYNN (LPC)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:RUTHERFORD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5310 BRAZOS RIVER RD
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:TX
Mailing Address - Zip Code:77541-8244
Mailing Address - Country:US
Mailing Address - Phone:512-289-0922
Mailing Address - Fax:
Practice Address - Street 1:5310 BRAZOS RIVER RD
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:TX
Practice Address - Zip Code:77541-8244
Practice Address - Country:US
Practice Address - Phone:512-289-0922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13307101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0277980-01Medicaid